Nanotechnology in Skin, Soft Tissue, and Bone Infections 9783030351465, 9783030351472, 3030351467

The main goal of the present book is to deal with the role of nanobiotechnology in skin, soft tissue and bone infections

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Nanotechnology in Skin, Soft Tissue, and Bone Infections
 9783030351465, 9783030351472, 3030351467

Table of contents :
Part I: Skin Infections
Chapter 1: Nitric Oxide-Releasing Nanomaterials and Skin Infections
1.1 Introduction
1.2 NO and Human Skin
1.3 Delivering NO to Human Skin
1.4 Nanoparticles for Dermatological Applications
1.4.1 Liposomes
1.4.2 Polymeric Nanoparticles
1.4.3 Metallic Nanoparticles
1.5 NO-Releasing Nanomaterials for Biomedical Purposes
1.5.1 NO-Releasing Nanoparticles in the Management of Skin Infection Bacterial Infections Fungal Infections Parasitic Infections
1.6 Conclusions
Chapter 2: Metal Nanoparticle Based Antibacterial Nanocomposites for Skin Infections
2.1 Introduction
2.2 Anatomy and Physicochemical Properties of Skin
2.3 Type of Bacterial Infections in Skin
2.4 Emergence of Various Types of Metal Nanoparticles (MNPs) and Its Composites
2.5 Essences of New Class of Nanoscale Materials Suitable Against Skin Infections
2.6 Nanoscale Materials as Antibacterial Skincare Agents
2.6.1 Metal Nanoparticles Silver Nanoparticles (Ag NPs) Gold Nanoparticles (Au NPs)
2.6.2 Metal Oxide NPs Titanium Dioxide Nanoparticles Zinc Oxide Nanoparticles Copper Oxide Nanoparticles Other Metal Oxide Nanoparticles
2.6.3 Nanocomposites
2.7 Proposed Mathematical Models of Penetration of NPs Through Skin
2.8 Diffusion of NPs Through Skin
2.8.1 Mathematical Model for Diffusion Through Skin
2.8.2 Metal and Metal Oxide NPs Diffusion Through Skin
2.9 Conclusion
Chapter 3: Combination Therapy Using Metal Nanoparticles for Skin Infections
3.1 Introduction
3.2 Skin Infections
3.3 Types of Skin Infections
3.3.1 Bacterial Skin Infections
3.3.2 Fungal Skin Infections Athlete’s Foot or Tinea pedis Jock Itch or Tinea cruris Ringworm or Tinea corporis Yeast Infections
3.3.3 Viral Skin Infections Herpes Simplex Virus (HSV) Chickenpox (Varicella zoster) Shingle (Herpes zoster) Molluscum Contagiosum Measles and Rubella Hand-Foot-and-Mouth Disease Roseola Warts
3.3.4 Parasitic Infections
3.4 Metal and Metal Oxide Nanoparticles on Skin Infections
3.4.1 Silver Nanoparticles (AgNPs)
3.4.2 Gold Nanoparticles (AuNPs)
3.4.3 Copper Nanoparticles (CuNPs)
3.4.4 Copper Oxide Nanoparticles (CuO NPs)
3.4.5 Titanium Oxide Nanoparticles (TiO2 NPs) and Zinc Oxide Nanoparticles (ZnO NPs)
3.5 Human Skin Penetration of Metallic Nanoparticles
3.6 Combined Therapy of Metallic Nanoparticles in Bacterial Skin Infections
3.7 Combined Therapy of Metallic Nanoparticles in Fungal Skin Infections
3.8 Combined Therapy of Metallic Nanoparticles in Viral Skin Infections
3.9 Combined Therapy of Metal Nanoparticles in Parasitic Skin Infections
3.10 Nanoparticles and Skin Cancers
3.11 Conclusions and Future Perspectives
Chapter 4: Applications of Nanometals in Cutaneous Infections
4.1 Introduction
4.2 Acne Vulgaris: Conventional Treatment and Nanotherapy
4.3 Mycoses: Definition, Etiology, Conventional Treatment, Nanotherapy
4.4 Leishmaniasis: Definition, Etiology, Conventional Treatment, Nanotherapy
4.5 Wounds: Definition, Etiology, Conventional Treatment, Nanotherapy
4.6 Toxicity of Metallic and Metal Oxide Nanoparticles
4.7 Conclusion and Future Perspectives
Chapter 5: Antifungal Nanotherapy: A Novel Approach to Combat Superficial Fungal Infections
5.1 Introduction
5.2 Nanoparticles for Superficial Fungal Infections
5.2.1 Antifungal Metal Nanoparticles Chemically Synthesized Nanoparticles Biologically Synthesized Nanoparticles
5.2.2 Non-metal Antifungal Nanoparticles
5.3 Nanoparticles as Antifungal-Carriers for Superficial Fungal Infections
5.3.1 Liposomal Drug Delivery Systems
5.3.2 Nanofibrous Drug Delivery Systems
5.4 Concluding Remarks and Future Perspectives
Chapter 6: Role of Nanostructured Materials in the Treatment of Superficial Yeast Infections
6.1 Introduction
6.2 Nanomaterials and Biomedical Applications of Nanotechnology
6.3 Role of Nanoparticles in the Treatment of Yeast Infections
6.4 Nanoformulations
6.5 Conclusion
Chapter 7: Essential Oil Encapsulated in Nanoparticles for Treatment of Skin Infections
7.1 Introduction
7.2 Nanoparticles Encapsulated with Essential Oils
7.3 Conclusion and Future Perspectives
Part II: Soft Tissue Infections
Chapter 8: Nanotechnological Approaches to Manage Diabetic Foot Ulcer
8.1 Introduction
8.2 Pathology of Diabetic Foot Ulcer
8.3 Evaluation and Standard of Care: Diabetic Foot Ulcer
8.4 Nanotechnology and DFUs
8.4.1 Silver Nanoparticles (AgNPs)
8.4.2 Zinc Oxide Nanoparticles (ZnONPs)
8.4.3 Gold Nanoparticles (AuNPs)
8.4.4 Copper-Based Nanoparticles
8.4.5 Cerium Oxide Nanoparticles (CeO2 NPs)
8.4.6 Polymeric Nanoparticles
8.4.7 Peptide-Based Nanoparticles (Growth Factors-GFs)
8.4.8 Antibiotics-Based Nanoparticles
8.4.9 Antioxidant-Based Nanoparticles (NO-NPs)
8.4.10 Lipid-Based Nanoparticles
8.4.11 siRNA Incorporated Nanoparticles
8.4.12 Stem Cell-Based Nanoparticles
8.5 Conclusion
8.6 Future Perspectives
Chapter 9: Silver Nanoparticles in Wound Infections: Present Status and Future Prospects
9.1 Introduction
9.2 Silver-Based Antimicrobials in Wound Infection
9.3 Silver, Wound Infection, and Healing
9.4 The Effect of Silver Nanoparticles on Wounds
9.5 Mechanisms of Silver Resistance
9.6 Toxicity of Silver Nanoparticles
9.7 Conclusion
Chapter 10: Applications of Chitosan and Nanochitosan in Formulation of Novel Antibacterial and Wound Healing Agents
10.1 Introduction
10.2 Antibacterial Activities of Chitosan
10.3 Wound Healing Activities of Chitosan
10.4 Chitosan/Cellulose
10.5 Chitosan/Alginic Acid
10.6 Chitosan/Collagen
10.7 Hyaluronic Acid
10.8 Starch
10.9 Chondroitin Sulfate
10.10 Conclusion and Future Perspectives
Chapter 11: Nanobiotechnological Strategies for Treatment of Tegumentary and Visceral Leishmaniasis Including Resistance Strains
11.1 Introduction
11.2 Current Treatment and Unresponsive Drugs
11.3 Drug Delivery System Against Leishmaniasis
11.3.1 Transdermal Drug Delivery Nanocarrier as Strategy for Leishmanicidal Activity
11.3.2 Liposome-Based Formulation
11.3.3 Cyclodextrin-Based Formulation
11.3.4 Self-Emulsifying Drug Delivery System
11.3.5 Transfersomes
11.3.6 Ethosomes
11.3.7 Niosomes
11.3.8 Microemulsion, Nanoemulsion, and Pickering Emulsion
11.4 Vaccines and New Perspectives
11.5 Conclusion
Chapter 12: Additive Manufacturing and Nanotherapeutics: Present Status and Future Perspectives in Wound Healing
12.1 Introduction
12.2 Current Status and Scope of Nanotherapeutics in Wound Healing
12.2.1 Nanomaterials as Intrinsic Therapeutic Agents
12.2.2 Nanomaterials as Carriers for Therapeutic Agents
12.3 3D Scaffolds for Wound Healing: Scope for Additive Manufacturing Techniques
12.4 Additive Manufacturing and Nanotherapeutics
12.5 Conclusion and Future Perspective
Part III: Bone Infections and Toxicity
Chapter 13: The Bone Biology and the Nanotechnology for Bone Engineering and Bone Diseases
13.1 Introduction
13.2 The Bone Tissue
13.3 Types of Bone
13.4 Osteogenesis
13.5 Structure and Micro-architecture of the Bone
13.6 Vascularization and Innervation of the Bone
13.7 Bone Repair: Stages of the Bone Healing
13.8 Basic Concepts in Implantology
13.9 Biomaterials and Nanotechnology
13.10 Nanotechnology in Bone Tissue Engineering
13.11 Nanotechnology in Bone Diseases
13.12 Conclusion and Future Perspectives
Chapter 14: Diabetic Foot Osteomyelitis: Control and Therapy Through Nanotechnology
14.1 Introduction
14.2 Pathophysiology
14.3 Microbiology
14.4 Classification of Diabetic Foot Osteomyelitis
14.5 Diagnosis
14.5.1 Inflammatory Markers and Blood Tests
14.5.2 Bone Exposure and Probe-to-Bone Tests
14.5.3 Plain Radiographs
14.5.4 Radiolabeled White Blood Cell Scanning
14.5.5 Computed Tomography (CT)
14.5.6 Magnetic Resonance Imaging (MRI)
14.6 Medical Management
14.6.1 Antimicrobial Treatment Duration
14.6.2 Traditional Surgical Management
14.6.3 Conservative Surgery or Medicosurgical Management
14.7 Clinical Evaluation
14.8 Nanotechnology in OM
14.8.1 Hydroxyapatite Nanoparticles
14.8.2 Calcium Phosphate Nanoparticles
14.8.3 Poly (Lactic-co-Glycolic Acid) (PLGA) Nanoparticles
14.8.4 Metallic Nanoparticles
14.8.5 Silver Nanoparticles
14.8.6 Titanium Nanoparticles
14.8.7 Carbon Nanotubes
14.8.8 Lipid Nanoparticles
14.9 Conclusions
Chapter 15: Genotoxicity of Silver Nanoparticles (Ag-NPs) in In Vitro and In Vivo Models
15.1 Introduction
15.2 Mechanisms of Nanoparticle-Induced Genotoxicity
15.3 Methods for Genotoxicity Testing
15.3.1 Ames Test
15.3.2 Chromosome Aberration Test
15.3.3 Comet Assay
15.3.4 Cytokinesis-Blocked Micronucleus Assay
15.3.5 HPRT Forward Mutation Assay
15.3.6 g-H2AX Staining
15.3.7 8-Hydroxydeoxyguanosine DNA Adducts
15.4 Genotoxicity of Silver NPs (Ag-NPs)
15.5 Conclusion and Future Perspectives

Citation preview

Mahendra Rai Editor

Nanotechnology in Skin, Soft Tissue, and Bone Infections

Nanotechnology in Skin, Soft Tissue, and Bone Infections

Mahendra Rai Editor

Nanotechnology in Skin, Soft Tissue, and Bone Infections

Editor Mahendra Rai Nanobiotechnology Laboratory Department of Biotechnology Amravati, Maharashtra, India

ISBN 978-3-030-35146-5    ISBN 978-3-030-35147-2 (eBook) © Springer Nature Switzerland AG 2020 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland


Skin, soft tissue, and bone infections are increasing due to the invasion of a wide variety of microorganisms, including bacteria, fungi, viruses, and protozoa. Usually, these infections are mild but they are sometimes fatal to human beings. Such infections can be cutaneous, subcutaneous, or deep-seated in tissues. Among these, bacterial infections occur commonly throughout the world and have created the problem of resistance to drugs. There are alarming reports of methicillin-resistant Staphylococcus aureus (MRSA), which accounts for the major part of communityacquired skin infections. Streptococci are also responsible for such infections. These infections are more common in immunocompromised patients. Unfortunately, the rate of development of antibiotics is very slow, and the problem of multidrugresistance is quickly increasing. These infections are booming in hospitals and mostly community-acquired. Considering these facts, there is a greater need to search for newer antibiotics or potential alternatives to tackle the problem. In this context, nanotechnology is emerging as a potential tool to fight against multidrug-resistant microbes. It has demonstrated huge potential for the treatment of bone infections through the application of antibacterial nanomaterials. Many nanobiomaterials have been studied for scaffold reinforcement to improve their micromechanical and biocompatible properties. For example, calcium phosphate (CaP) bioceramics are commonly used as local delivery agents (nanocarriers) for the treatment of bone infections and can be substituted with antibacterial nanoparticles that possess broad-spectrum activity even against multidrug-resistant bacteria. Metal nanoparticles such as silver nanoparticles and other antimicrobial nanomaterials can be used for coating of implants. This self-assembly at the nanolevel at body temperature may, in the future, be used by way of side chains to direct bone growth or possibly to combat osteomyelitis. Silver nanoparticles are yet another nanostructured material that is attracting increasing attention as an effective antimicrobial agent. Wound dressings impregnated with silver nanoparticles have already proven their remarkable potential against Gram-positive and Gram-negative bacteria. The present book covers the role of nanotechnology in skin infections such as atopic dermatitis and acne vulgaris, as well as the role of metal nanoparticles as antibacterial and antifungal. It additionally elaborates on the management of wound v



and bone infections using different nanoparticles. Finally, this book discusses toxicity issues concerning the use of nanoparticles. This book will be useful for master and postgraduate students, researchers, and teachers dealing with medical microbiology, dermatology, osteology, nanotechnology, nanobiotechnology, pharmacology, microbiology, and biotechnology. Amravati, Maharashtra, India

Mahendra Rai


Part I Skin Infections 1 Nitric Oxide-Releasing Nanomaterials and Skin Infections����������������    3 Joana C. Pieretti and Amedea B. Seabra 2 Metal Nanoparticle Based Antibacterial Nanocomposites for Skin Infections������������������������������������������������������������������������������������   25 Arushi Verma, Vishal Singh, and Amaresh Kumar Sahoo 3 Combination Therapy Using Metal Nanoparticles for Skin Infections������������������������������������������������������������������������������������   49 Debalina Bhattacharya, Rituparna Saha, and Mainak Mukhopadhyay 4 Applications of Nanometals in Cutaneous Infections ��������������������������   71 Gerson Nakazato, Audrey Alesandra Stinghen Garcia Lonni, Luciano Aparecido Panagio, Larissa Ciappina de Camargo, Marcelly Chue Gonçalves, Guilherme Fonseca Reis, Milena Menegazzo Miranda-Sapla, Fernanda Tomiotto-Pellissier, and Renata Katsuko Takayama Kobayashi 5 Antifungal Nanotherapy: A Novel Approach to Combat Superficial Fungal Infections������������������������������������������������������������������   93 Farnoush Asghari-Paskiabi, Zahra Jahanshiri, Masoomeh Shams-­­Ghahfarokhi, and Mehdi Razzaghi-Abyaneh 6 Role of Nanostructured Materials in the Treatment of Superficial Yeast Infections����������������������������������������������������������������  109 Mahendra Rai and Alka Yadav 7 Essential Oil Encapsulated in Nanoparticles for Treatment of Skin Infections�������������������������������������������������������������������������������������  121 Hercília Maria Lins Rolim and Thais Cruz Ramalho




Part II Soft Tissue Infections 8 Nanotechnological Approaches to Manage Diabetic Foot Ulcer����������  135 Aswathy Jayakumar and E. K. Radhakrishnan 9 Silver Nanoparticles in Wound Infections: Present Status and Future Prospects ������������������������������������������������������������������������������  151 Hanna Dahm 10 Applications of Chitosan and Nanochitosan in Formulation of Novel Antibacterial and Wound Healing Agents������������������������������  169 Mehran Alavi 11 Nanobiotechnological Strategies for Treatment of Tegumentary and Visceral Leishmaniasis Including Resistance Strains�������������������  183 Marco Vinicius Chaud, Venâncio Alves Amaral, Fernando Batain, Kessi Marie Moura Crescencio, Carolina Alves dos Santos, Márcia Araújo Rebelo, and Victória Soares Soeiro 12 Additive Manufacturing and Nanotherapeutics: Present Status and Future Perspectives in Wound Healing������������������������������������������  205 Parneet Kaur Deol, Amoljit Singh Gill, Sushant Prajapati, and Indu Pal Kaur Part III Bone Infections and Toxicity 13 The Bone Biology and the Nanotechnology for Bone Engineering and Bone Diseases��������������������������������������������������������������  223 Fabio Franceschini Mitri and Avinash P. Ingle 14 Diabetic Foot Osteomyelitis: Control and Therapy Through Nanotechnology������������������������������������������������������������������������  245 Vandita Kakkar, Parina Kumari, Priyanka Narula, and Mohd Yaseen 15 Genotoxicity of Silver Nanoparticles (Ag-NPs) in In Vitro and In Vivo Models����������������������������������������������������������������������������������  269 Anita K. Patlolla and Paul B. Tchounwou Index������������������������������������������������������������������������������������������������������������������  283


Mehran Alavi  Laboratory of Nanobiotechnology, Department of Biology, Faculty of Science, Razi University, Kermanshah, Iran Venâncio  Alves  Amaral  Laboratory of Biomaterials and Nanotechnology, University of Sorocaba, Sorocaba, São Paulo, Brazil Farnoush Asghari-Paskiabi  Department of Mycology, Pasteur Institute of Iran, Tehran, Iran Fernando Batain  Laboratory of Biomaterials and Nanotechnology, University of Sorocaba, Sorocaba, São Paulo, Brazil Debalina  Bhattacharya  Department of Microbiology, Maulana Azad College, Kolkata, West Bengal, India Marco  Vinicius  Chaud  Laboratory of Biomaterials and Nanotechnology, University of Sorocaba, Sorocaba, São Paulo, Brazil Kessi Marie Moura Crescencio  Laboratory of Biomaterials and Nanotechnology, University of Sorocaba, Sorocaba, São Paulo, Brazil Hanna  Dahm  Department of Microbiology, Nicolaus Copernicus University, Torun, Poland Larissa Ciappina de Camargo  Department of Microbiology, Biological Sciences Center, Universidade Estadual de Londrina, Londrina, Paraná, Brazil Parneet  Kaur  Deol  Department of Pharmaceutics, G.H.G.  Khalsa College of Pharmacy, Gurusar Sadhar, Ludhiana, Punjab, India Carolina  Alves  dos Santos  College of Pharmacy, University of Sorocaba, Sorocaba, São Paulo, Brazil Amoljit  Singh  Gill  Department of Mechanical Engineering, Punjab Technical University, Kapurthala, Punjab, India




Marcelly  Chue  Gonçalves  Department of Microbiology, Biological Sciences Center, Universidade Estadual de Londrina, Londrina, Paraná, Brazil Avinash  P.  Ingle  Department of Biotechnology, Engineering School of Lorena, University of Sao Paulo, Lorena, SP, Brazil Zahra Jahanshiri  Department of Mycology, Pasteur Institute of Iran, Tehran, Iran Aswathy  Jayakumar  School of Biosciences, Mahatma Gandhi University, Kottayam, Kerala, India Vandita Kakkar  Department of Pharmaceutical Sciences, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India Indu  Pal  Kaur  Department of Pharmaceutics, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India Renata Katsuko Takayama Kobayashi  Department of Microbiology, Biological Sciences Center, Universidade Estadual de Londrina, Londrina, Paraná, Brazil Parina  Kumari  Department of Pharmaceutical Sciences, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India Audrey  Alesandra  Stinghen  Garcia  Lonni  Department of Pharmaceutical Sciences, Health Sciences Center, Universidade Estadual de Londrina, Londrina, Paraná, Brazil Milena  Menegazzo  Miranda-Sapla  Department of Pathological Sciences, Biological Sciences Center, Universidade Estadual de Londrina, Londrina, Paraná, Brazil Fabio Franceschini Mitri  Department of Human Anatomy, Biomedical Sciences Institute, Federal University of Uberlandia, Uberlandia, MG, Brazil Mainak Mukhopadhyay  Department of Biotechnology, JIS University, Kolkata, West Bengal, India Gerson  Nakazato  Department of Microbiology, Biological Sciences Center, Universidade Estadual de Londrina, Londrina, Paraná, Brazil Priyanka Narula  Department of Pharmaceutical Sciences, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India Luciano  Aparecido  Panagio  Department of Microbiology, Biological Sciences Center, Universidade Estadual de Londrina, Londrina, Paraná, Brazil Anita  K.  Patlolla  CSET, Department of Biology, Jackson State University, Jackson, MS, USA Joana  C.  Pieretti  Center for Natural and Human Sciences (CCNH), Federal University of ABC (UFABC), Santo André, SP, Brazil Sushant Prajapati  Department of Biotechnology and Medical Engineering, NIT, Rourkela, India



E.  K.  Radhakrishnan  School of Biosciences, Mahatma Gandhi University, Kottayam, Kerala, India Mahendra  Rai  Nanobiotechnology Laboratory, Department of Biotechnology, Amravati, Maharashtra, India Thais Cruz Ramalho  Laboratory of Pharmaceutical Nanosystems—NANOSFAR, Postgraduate Program in Pharmaceutical Sciences, Federal University of Piauí, Teresina, Piauí, Brazil Mehdi  Razzaghi-Abyaneh  Department of Mycology, Pasteur Institute of Iran, Tehran, Iran Márcia  Araújo  Rebelo  College of Pharmacy, Max Planck University Center, Indaiatuba, São Paulo, Brazil Guilherme  Fonseca  Reis  Department of Microbiology, Biological Sciences Center, Universidade Estadual de Londrina, Londrina, Paraná, Brazil Hercília  Maria  Lins  Rolim  Laboratory of Pharmaceutical Nanosystems— NANOSFAR, Postgraduate Program in Pharmaceutical Sciences, Federal University of Piauí, Teresina, Piauí, Brazil Rituparna  Saha  Department of Biotechnology, JIS University, Kolkata, West Bengal, India Amaresh  Kumar  Sahoo  Department of Applied Sciences, Indian Institute of Information Technology, Allahabad, India Amedea  B.  Seabra Center for Natural and Human Sciences (CCNH), Federal University of ABC (UFABC), Santo André, SP, Brazil Masoomeh  Shams-Ghahfarokhi  Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran Vishal  Singh Department of Applied Sciences, Indian Institute of Information Technology, Allahabad, India Victória  Soares  Soeiro Laboratory of Biomaterials and Nanotechnology, University of Sorocaba, Sorocaba, São Paulo, Brazil Paul  B.  Tchounwou CSET, Department of Biology, Jackson State University, Jackson, MS, USA Fernanda  Tomiotto-Pellissier  Carlos Chagas Institute (ICC), Fiocruz, Curitiba, Paraná, Brazil Arushi  Verma  Department of Applied Sciences, Indian Institute of Information Technology, Allahabad, India Alka Yadav  Department of Biotechnology, Sant Gadge Baba Amravati University, Amravati, Maharashtra, India Mohd  Yaseen  Department of Pharmaceutical Sciences, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India

Part I

Skin Infections

Chapter 1

Nitric Oxide-Releasing Nanomaterials and Skin Infections Joana C. Pieretti and Amedea B. Seabra

Abstract  The free radical nitric oxide (NO) is an important endogenous molecule that controls several biological processes, ranging from the promotion of vasodilatation to the acceleration of wound repair process and potent antimicrobial effects. NO is synthesized in human skin through the action of three isoforms of nitric oxide synthase (NOS), with an important role in dermal vasodilatation, wound healing process, tissue repair, and skin defense against pathogens. During the past few years, interest has increased in the development of biologically friendly and versatile NO-releasing materials for biomedical applications, in particular, for topical/ dermatological applications. Recently, the combination of NO donors/generations with nanomaterials has been emerging as a suitable strategy to carry and deliver therapeutic amounts of NO directly to the target site of application, including human skin, as discussed in this chapter. Thus, NO-releasing nanomaterials present great potential to treat skin diseases, highlighting skin infections caused by pathogens, because of the broad spectrum of antimicrobial activity of NO. In this sense, NO donors/generators have been incorporated in nanoparticles, leading to a sustained and localized delivery of NO. This chapter presents and discusses the recent advantages on the design and applications of NO-releasing nanomaterials for dermatological applications, mainly in promoting wound healing and in combating resistant pathogens. Keywords  Antimicrobial · Nanomaterials · Nanoparticles · Nitric oxide · Nitric oxide donors · Skin infections

J. C. Pieretti · A. B. Seabra (*) Center for Natural and Human Sciences (CCNH), Federal University of ABC (UFABC), Santo André, SP, Brazil e-mail: [email protected] © Springer Nature Switzerland AG 2020 M. Rai (ed.), Nanotechnology in Skin, Soft Tissue, and Bone Infections,



J. C. Pieretti and A. B. Seabra

Nomenclature AgNPs Silver nanoparticles AuNPs Gold nanoparticles eNOS Endothelial nitric oxide synthase GSNO S-Nitroso glutathione iNOS Inducible nitric oxide synthase MRSA Methicillin-resistant Staphylococcus aureus MSSA Methicillin-sensitive Staphylococcus aureus nNOS Neuronal nitric oxide synthase NO Nitric oxide NO2− Nitrite NO3− Nitrate NOS Nitric oxide synthase O2 Oxygen RONO2 NO-releasing organic nitrates RSNO S-Nitroso molecules UV Ultraviolet radiation UVA Ultraviolet A radiation

1.1  Introduction More than two decades ago, nitric oxide (NO) was only known by its significant role in atmosphere phenomena and pollution, contributing to ozone removal from high levels of the atmosphere. In 1992, NO was considered the molecule of the year by Science (Koshland 1992). In 1998, the Nobel Prize of Medicine and Physiology was awarded to Robert F.  Furchgott, Louis J.  Ignarro, and Ferid Murad for their path-breaking discoveries regarding the effects of NO on the cardiovascular system (Ignarro 1999; Seabra 2017; Stuehr and Haque 2018). NO is not only a key molecule in the cardiovascular system, but it also controls various fundamental physiological processes, such as cell communication (Eileen et al. 2016), blood pressure control and vasodilatation (Seabra et al. 2015), antitumor and antimicrobial activities (Mollick et al. 2015), and promotion and acceleration of wound healing and tissue repair processes, among others (Seabra 2017). NO is a small, diatomic molecule, found in the gaseous state, and is a free radical because it has an unpaired electron at the π∗ orbital. Because of its relative lipophilicity, NO freely diffuses within cell membranes, allowing important cell communication (Aktan 2004). In vivo, NO is synthesized by the action of the enzyme nitric oxide synthase (NOS), which catalyzes the oxidation of L-arginine to L-citrulline, producing NO (Aktan 2004; Seabra and Durán 2018). NOS presents as three isoforms:

1  Nitric Oxide-Releasing Nanomaterials and Skin Infections


1. Endothelial (eNOS), which is able to produce NO in picomolar to nanomolar concentrations in a calcium- dependent manner. 2. Neuronal (nNOS), which is able to produce NO in picomolar to nanomolar range in calcium- dependent manner. 3. Inducible (iNOS), which produces considerably higher amounts of NO for longer periods of time, in the micromolar to millimolar range, in a calcium -independent manner. iNOS is induced by immuno stimuli, and NO produced by iNOS is a potent antimicrobial agent. After the discovery of key functions of NO in the biological system, several studies have established NO as a fascinating versatile molecule regulating key functions in many organs, including the human skin (Ignarro 2000). NO has been intensively studied for the past 20 years. Advances in the knowledge of NO biological mechanisms, the design of targeted NO delivery systems, and sustained exogenous NO release in different therapies have been successfully achieved for several biomedical applications (Stuehr and Haque 2018). Figure 1.1 indicates a continuous increase in scientific papers with the key words “nitric oxide” in the heading, according to Web of Science from 1990 until now. It is notable that there has been a great increase in the number of scientific publications in the first decade after the Nobel Prize was awarded to Robert F. Furchgott, Louis J. Ignarro, and Ferid Murad, which has followed a linear increase during the past years, reaching an average number of publications of 10,000 scientific papers per year. The scientific journal Nitric Oxide, the official journal of the Nitric Oxide Society, also indicates the importance of studies based on the chemistry and biology of this molecule, with an increasing impact

Fig. 1.1  Number of published papers, between 1990 and 2019, with the keyword “nitric oxide” in the heading obtained via Web of Science


J. C. Pieretti and A. B. Seabra

f­actor of 3.45  in 2010 to 4.37 at the present time ( nitric-oxide). NO, which is one of the most studied biological molecules, is a key regulator in many organs, including the human skin. The functions of NO in human skin cover such diverse topics as (1) dermal vasodilatation, (2) inflammation, (3) infection, (4) wound healing, (5) tissue repair, and (6) skin cancer (Cals-Grierson and Ormerod 2004; Seabra et al. 2004; Amadeu et al. 2007; Seabra 2017). In this direction, this chapter focuses in the roles of NO in human skin, particularly in the combat of skin infections, highlighting the promising use of exogenous NO donors allied to nanomaterials to combat skin infections.

1.2  NO and Human Skin Skin is the largest organ of the body and provides important functions such as protection, thermoregulation, somatosensory and antioxidant activity, and antibacterial and immunological actions (Stancic et al. 2019). NO and other reactive species are expressed in the skin and contribute to the regulation of physiological and pathophysiological conditions in skin diseases (Jankovic et  al. 2016), highlighting the promotion of the wound healing process and the control of infection and inflammation processes (Heuer et al. 2015). In the skin, NO is produced from all three isoforms of NOS: eNOS, nNOS, and iNOS (Holliman et al. 2017), and it is mostly distributed in keratinocytes, fi ­ broblasts, melanocytes, and endothelial cells (Stancic et  al. 2019). eNOS and nNOs are expressed in the epidermis and dermis layers, in melanocytes and keratinocytes, and iNOS was detected in almost all types of cells in skin after cytokine stimulation (Yarlagadda et  al. 2017). Figure  1.2 represents the schematic production of NO from NOS in the skin and its activity. Low concentrations of NO (pico- to nanomolar range), synthesized by eNOs/ nNOs in the skin, are responsible for the control of physiological functions in the skin, such as the promotion and acceleration of wound healing, skin pigmentation, and dermal circulation (Ignarro 2000; Georgii et al. 2011; Seabra 2011). In contrast, high concentrations of NO ( micro- to milli molar range) produced by iNOS have cytotoxic effects acting in skin defense against infections and skin cancer (Ignarro 2000; Englander and Friedman 2010; Seabra 2011, 2017). The antimicrobial activity of NO involves its mediation in cytotoxic events in host defense against pathogenic agents (bacteria, fungi, parasites) (Schairer et al. 2012). Upon stimulation of tumor necrosis factor and cytokines, NO is synthesized by iNOS in pathological conditions by macrophages and other cell types (Lyons 1995). NO produced by iNOS has viricidal, antibacterial, antiparasitic, and tumoricidal activity (Halpenny and Mascharak 2010.). The antimicrobial activity of NO involves diverse mechanisms, including (1) impairment of the replication of pathogen DNA, (2) inhibition of mitochondrial respiration by interfering in the electron transport chain in pathogen key enzymes, (3) promotion of S-nitrosation reactions

1  Nitric Oxide-Releasing Nanomaterials and Skin Infections


Fig. 1.2  Endogenous synthesis of nitric oxide (NO) via nitric oxide synthase (NOS) and its activity in human skin

of cysteine residues of important pathogen enzymes, and (4) generation of other oxygen and nitrogen reactive species (NOx) (Seabra et al. 2016). For reasons of its lipophilicity, NO can easily diffuse through the membranes of pathogens. Once internalized, NO reacts with intracellular targets, leading to toxic effects. NO rapidly and efficiently reacts with superoxide anion radical (O2•−), a product of bacteria cellular respiration, leading to the formation of the highly toxic and oxidant peroxynitrite (ONOO−) (Eq. 1.1).

NO• + O2 • − → ONOO − .


Once produced, peroxynitrite causes severe and irreversible biological damage to the pathogens, including formation of nitrosyl moieties through the attack of metabolic heme-containing enzymes, DNA damage, and peroxidation of the lipid membrane, yielding impairment of the metabolism of skin pathogens (Fang 1997). Therefore, NO is directly involved in host defense against many skin diseases caused by bacteria, fungi, and protozoa. Recently, it has been reported that human skin is able to store the free radical NO in more stable species (NOx) (Mowbray et al. 2009; Liu et al. 2014; Weller 2016). The main NOx species that are stored in human skin are nitrite (NO2−), nitrate (NO3−), and S-nitrosothiols (RSNOs). In human skin, these NOx species can release free NO from the skin to the bloodstream upon irradiation with ultraviolet (UV) light (Mowbray et al. 2009; Weller 2016; Pelegrino et al. 2017). UV light-targeted exposure can activate and increase the expression of NOS, resulting in the growth of iNOS in skin after 8–10 h of exposure (Kuhn et al. 1998). In this sense, NO can


J. C. Pieretti and A. B. Seabra

Fig. 1.3  Schematic representation of NOx species present in human skin: nitrites, nitrates, and S-nitroso molecules (RSNOs), which can produce free NO triggered by UV irradiation

also be obtained by a nonenzymatic route, specially by NO3− and NO2− reduction, and from decomposition of S-nitroso molecules (RSNO), such as S-nitrosoalbumin, S-nitrosoglutathione, and S-nitrosocysteine, so- called photolabile compounds that can be triggered by blue light or ultraviolet A (UVA) radiation exposure (Opländer et al. 2013). Under UV irradiation, S-nitroso molecules photodecompose, releasing NO, while NO3− is reduced to NO2−, which is further reduced to NO (Opländer and Suschek 2013). The radiation induces the decomposition of the related NOx species present in the stratum corneum and epidermis, generating free NO in human skin. NO can permeate skin layers and diffuse from the skin into blood vessels, where it will be further oxidized to nitrite or nitrate, whereas RSNOs can enter the blood system and release free NO, acting as a vasoactive agent (Opländer and Suschek 2013). The role of NO2−, NO3−, and RSNO in skin is schematically represented in Fig. 1.3.

1.3  Delivering NO to Human Skin The involvement of NO in many physiological and pathophysiological responses in human skin has led to increasing interest in the development of NO-releasing biomaterials for dermatological purposes, mainly to treat skin infections (Seabra 2011). In this direction, exogenous delivery of NO/NO donors in topical applications

1  Nitric Oxide-Releasing Nanomaterials and Skin Infections


p­ resents great potential to enhance the bioavailability of this molecule in skin and, depending on the dosage, a targeted application can be achieved, leading to wound healing (low concentrations) or to combat skin infections (high concentrations of NO, micro- to milli molar range) (Gutiérrez et al. 2016). As a free radical, NO has a short half-life of 1–5 s in the human; it can rapidly react with different radical species such as molecular oxygen (O2), leading to the formation of oxidized species including NO2− and NO3− (Yang et al. 2015). In addition, NO can react with oxyhemoglobin, leading to the formation of methemoglobin and nitrate; this process leads to the inactivation of NO (Doyle and Hoekstra 1981). Therefore, there is increasing interest in the design of strategies to deliver therapeutic amounts of NO in dermatological applications to treat skin infections. In this sense, NO donors are molecules that present NO in their structure and that are able spontaneously and continuously release NO in situ, for longer periods ranging from hours to days (Wang et al. 2002). There are several classes of NO donors , such as organic nitrates (RONO2), the oldest class of NO donors that have been clinically applied, S-nitrosothiols, also naturally present in skin, which are able to photorelease NO, metal–NO complexes, and hydroxylamines, among others. Although NO donors are able to increase NO half-life, the combination of NO donors with biomaterials/nanomaterials might significantly enhance the sustained release of therapeutic amounts of NO directly to the target site of application, for instance, in the skin (Friedman et al. 2008). Recently, the combination of NO donors and nanomaterials has been emerging as a suitable strategy to improve the pharmacokinetic, biodisponibility, and targeted release of NO in the treatment of skin infections (Quinn et al. 2015).

1.4  Nanoparticles for Dermatological Applications Regarding topical applications, it is important to remember that skin is a protective organ that is designed to avoid the penetration of external materials, and thus it is a challenge to develop formulations able to interact and penetrate the skin barrier (Hamblin et  al. 2016). The use of nanoparticles for dermatological applications might overcome this challenge, because, depending on the features of the nanomaterial, it can permeate skin, delivering the active drug directly to the skin (Basnet and Skalko-Basnet 2013). Nanomaterials are able to permeate skin barriers through the following routes: 1. Follicular route: nanoparticles are transported through the skin via a follicular penetration happening via sweat ducts, hair follicles, and sebaceous glands that can extend as much as 2 μm into the skin, enabling a controlled and localized release of molecules such as NO (Fang et al. 2014). 2. Intracellular lipidic route: nanoparticle permeation occurs between the corneocytes, diffusing through the intracellular lipid bilayer (Carter et al. 2019).


J. C. Pieretti and A. B. Seabra

3. Transcellular route: nanoparticles must traverse through alternate lipophilic and hydrophilic regions through the corneocytes (intracellularly), this being mostly an unfavorable route (Chevalier and Bolzinger 2015). It is important to highlight that nanoparticle diffusion through the skin is intrinsically dependent on various physicochemical aspects of the nanomaterial such as size, shape, weight, surface charge, and pH (Carter et al. 2019). In this regard, evaluation of the ability of different nanoparticles to act as a drug delivery system in dermatological applications is of fundamental importance to obtain a successful therapy (Parani et al. 2016). The incorporation of NO donors into nanomaterials has been recently explored for dermatological applications to combat skin infections, because high concentrations of NO have potent antimicrobial activity. Nanoparticles have the ability to load high NO concentrations, which is suitable for antimicrobial activity (Carpenter et al. 2012). Different types of nanomaterials that can be used for dermatological applications are described below.

1.4.1  Liposomes Liposomes are nanoscale lipid vesicles, formed by one or multiple bilayers composed of phospholipids and cholesterol. These nanoparticles are biodegradable and nontoxic, despite being able to load hydrophilic or hydrophobic molecules (Bozzuto and Molinari 2015). Liposomes easily penetrate the epidermal barrier when compared to other classes of nanoparticles because these are similar to the lipid composition of the epidermis. For this reason, studies focusing on liposomes composed of different types of phospholipids are a hot spot to enhance the skin penetration (Sakdiset et al. 2018).

1.4.2  Polymeric Nanoparticles Polymeric nanoparticles stand out when it comes to skin application mostly because drug degradation can be reduced by adjusting the nanoparticle physicochemical features, providing a controlled drug release (Hamblin et al. 2016). For this application, natural polymer-based nanoparticles mostly are investigated, highlighting chitosan nanoparticles that present controlled drug release for days and antiinflammatory and antibacterial properties in itself (Zou et  al. 2016). In addition, chitosan has mucoadhesive properties (Basha et al. 2018). Synthetic polymers such as polyalkylcyanoacrylates and polylactides are common because of their biocompatibility (Grumezescu 2016).

1  Nitric Oxide-Releasing Nanomaterials and Skin Infections


1.4.3  Metallic Nanoparticles Besides lipid and polymeric nanoparticles, metallic nanoparticles have also been investigated in dermatological applications for their unique properties controlled by choosing the composition of the material, size, and tunable surface characteristics (Goyal et al. 2016). Among various nanoparticles, silver nanoparticles (AgNPs) and gold nanoparticles (AuNPs) have been the most investigated in the field of topical applications (Carter et al. 2019). AgNPs presents great antibacterial and antiinflammatory properties, and their surface can be modified to release drugs and increase diffusion into the skin (Kraeling et al. 2018). AuNPs also present great potential to be functionalized and are notable because their size control enables diffusion even through intact skin (Huang et al. 2010). Thus, different classes of nanoparticles present great potential in skin treatment applications because most of them can permeate through skin, depending on their design during the synthesis. Furthermore, these nanoparticles can be loaded or functionalized with specific antimicrobial molecules, such as NO, enabling the development of NO-releasing nanoparticles that may enhance NO efficiency in skin application. Thus, the next section presents and discusses the combination of NO/NO donors with nanomaterials for the treatment of skin infections.

1.5  NO-Releasing Nanomaterials for Biomedical Purposes In biological media, NO donors present low stability, which leads to a noncontrolled and fast release of NO, limiting potential applications (Nguyen et al. 2016). A solution for this problem is the functionalization or encapsulation of NO donors in inorganic or polymeric nanoparticles, which have been studied by various research groups (Barraud et  al. 2012; Duong et  al. 2014; Seabra and Durán 2017a, b). NO-releasing nanoparticles may enhance NO stability as well as increasing the local concentration and solubility (Sun et al. 2014). Among various platforms for NO-releasing, polymeric nanoparticles stand out for encapsulating NO, acting as a barrier promoting a slow release. Nguyen et al. (2016) encapsulated NO donors in a polymeric nanoparticle based on oligo(ethylene glycol) methyl ether methacrylate. In this study, the prepared polymeric nanoparticles were able to load the NO donor N-diazeniumdiolate (NONOate) using highpressure NO gas for 48 h. After encapsulation, NO release was verified by amperometric measurements, at 37 °C, pH 7.4, which instantaneously measures NO released. In this system, NO was quickly released in the first 10 min, achieving 10 % of release; maximum release was 80%, after 17 h of monitoring. NO-releasing polymeric nanoparticles allied to gentamicin, a clinically used antibacterial drug, promoted the dispersal of Pseudomonas aeruginosa biofilms into an antibiotic­susceptible planktonic form. Figure 1.4 shows representative images obtained by


J. C. Pieretti and A. B. Seabra

Fig. 1.4  Representative confocal images of Pseudomonas aeruginosa biofilms stained with a LIVE/DEAD kit. Biofilms were grown for 6 h and then treated with NO donor spermine NONOate (Sper-NO), free gentamicin, or GEN-NO nanoparticles (NO-releasing nanoparticles), or left untreated for a further 1 h before staining. Viable and nonviable bacteria appear green and red, as well as those stained both green and red, respectively. Bar 50 μm. Note: Concentration is based on GEN: one mole of GEN-NO nanoparticles is equivalent to one mole of Sper-NO and gentamicin. (Reproduced from Nguyen et  al. 2016 under a Creative Commons Attribution 3.0 Unported Licence. Published by The Royal Society of Chemistry)

confocal microscopy of opportunistic pathogen Pseudomonas aeruginosa biofilms treated with free NO donor (Sper-NO, at concentration of 10 μM), free gentamicin (at 10 μM), and NO-releasing nanoparticles (Poly-GEN-NO, at 10 μM), compared to untreated Pseudomonas aeruginosa biofilm (Nguyen et al. 2016). The biofilms were stained with live/dead dyes: green color indicates live cells, and red color indicates dead cells. It can be clearly observed that biofilm treatment with NO-releasing nanoparticles (GEN-NO nanoparticles at 10 μM) significantly decreased biofilm volume, leading to a greater number of dead cells, in comparison with those treated with free NO donor, gentamicin alone, or the untreated group (Fig. 1.4).

1  Nitric Oxide-Releasing Nanomaterials and Skin Infections


Taken together, NO-releasing nanoparticles were able to release NO, which was made available to biofilms, and consequently induced dispersal of biofilm cells. Therefore, the nanoparticle is able to enhance the stability of the encapsulated NO donor from minutes to almost a day, facilitating potential biomedical applications (Keefer 2011). When it comes to topical application, polymeric nanoparticles usually are present in larger sizes, compared to metallic nanoparticles, which may hamper skin penetration. Chitosan nanoparticles are a hot topic, mostly for the possibility of loading several different classes of hydrophilic molecules, such as low molecular weight NO donors, and for reasons of their relatively small-sized nanoparticles (i.e., 40 nm), which are able to penetrate skin layers and deliver NO in the targeted location (Zhang et al. 2013). In this sense, Pelegrino and coworkers evaluated the potential dermatological applications of NO-releasing chitosan nanoparticles (Pelegrino et  al. 2017). The NO donor S-nitrosoglutathione (GSNO), which belongs to the class of S-nitrosothiols, was encapsulated into chitosan nanoparticles. Topical applications of NO-releasing chitosan nanoparticles directly on human skin allowed an efficiently transdermal NO permeation along the skin layers (Pelegrino et al. 2017). First, chitosan nanoparticles were obtained by a cross-link reaction with the polyanion tripolyphosphate, followed by the encapsulation of the NO donor via electrostatic interactions. The kinetics of NO release from chitosan nanoparticles was monitored, indicating a sustainable diffusion of the encapsulated NO donor. Regarding skin applications, after treating ex  vivo human skin slices with NO-releasing chitosan nanoparticles, it was possible to verify a significant increase in the levels of NO in treated skin, compared to nontreated skin, indicating that dermatological application of chitosan nanoparticles containing NO donors is able to promote NO diffusion through skin layers (Pelegrino et al. 2017). In addition to polymeric nanoparticles, inorganic nanoparticles have been extensively studied for drug transport and biomedical applications. Gold nanoparticles (AuNPs) are one of the most popular nanoparticles studied and have great potential in topical application in the treatment of skin diseases (Huang et al. 2010). Duong et al. (2014) prepared a 10- nm AuNP, coated with poly(oligoethylene glycol methyl ether methacrylate)-b-poly(vinyl benzyl chloride), in which amine groups were further converted to N-diazeniumdiolate NO donor, by exposure to NO gas at high pressure. NO release was monitored by the Griess method. In comparison to the free NO donor, encapsulated NO presented a slow release with no burst and a sustained release up to 6 days. Thus, this material is suitable for topical applications. Topical application of AuNPs has great potential because they penetrate the skin epidermis. The Yang research group demonstrated that small AuNPs (1–10 nm) can create channels through the skin barrier allowing loaded molecules to migrate in the epidermis and dermis. The authors demonstrated a high accumulation of AuNPs in epidermis and dermis (Duong et al. 2014). Thus, functionalization of AuNPs with NO donors is a suitable strategy regarding topical applications, enhancing sustainable NO release and penetration into the skin.


J. C. Pieretti and A. B. Seabra

1.5.1  N  O-Releasing Nanoparticles in the Management of Skin Infection Skin infection can be caused by a variety of microorganisms, such as bacteria, virus, fungi, and parasites, affecting high numbers in worldwide populations (Percival et al. 2012). One of the most common skin infections is caused by Staphylococcus aureus and its methicillin- resistant form, but other microorganisms are also commonly related to skin infections, including Pseudomonas aeruginosa, Escherichia coli, Staphylococcus epidermidis, Candida albicans, and Leishmania spp. (Percival et al. 2012). At low concentrations, NO can stimulate and reinforce the host immune system, whereas at higher concentrations, in the range of micro- to millimolar, NO acts as an antimicrobial agent against the pathogen. For this reason, NO donors have been used in the treatment of dermatological diseases (Seabra et al. 2015). NO donors can be incorporated into gels, creams, or nanoparticles for dermatological applications (Pelegrino et al. 2018). Some NO donors might be stable under ambient conditions, some of them present a long history of use with well- known side effects, and some are easily produced; however, they have some negative points such as limited antibacterial properties and lack of stability for topical uses (Adler and Friedman 2015). The incorporation of the NO donor into a gel, cream matrix, or nanoparticle represents an attractive strategy for allowing the dermatological administration of NO donors. This strategy is easily applied. NO-releasing nanoparticles are suitable for dermatological applications, with a broad spectrum of toxicity against numerous microorganisms, increasing NO stability in  localized applications (Adler and Friedman 2015). The next sections present and discuss selective examples of NO-releasing nanomaterials in the management of skin infections caused by different microorganisms.  Bacterial Infections One of the most common skin infections is caused by Staphylococcus aureus, leading to superficial and invasive infections, usually developed in the hospital environment (Clebak and Malone 2018). Looking forward to new therapeutics because of bacterial resistance, Martinez and coworkers developed a NO-releasing hydrogel/ glass nanoparticle, encapsulating sodium nitrite (NaNO2), and verified the potential of NO-generating nanoparticles against Staphylococcus aureus skin infections (Martinez et al. 2009). First, an in vitro evaluation was conducted with methicillin-­ resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA), indicating the NO-releasing nanoparticle toxicity against both forms caused cell wall destruction followed by cell lysis. In a further step, in vivo experiments in infected mice were carried out to evaluate the potential of NO-releasing nanoparticles to treat skin infection. The authors observed that NO-releasing nanoparticles exerted antimicrobial activity against MRSA in a

1  Nitric Oxide-Releasing Nanomaterials and Skin Infections


Fig. 1.5  Dermatological application of NO-releasing nanoparticles (NO-NP) accelerated wound healing process in mice. (a) Wounds of Balb/c mice untreated and Ab-infected, np-treated and Ab-infected, or Ab-infected NO-np-treated, 3 days post infection. Bar 5  mm. (b) Wound size analysis of Balb/c mice skin lesions. Time points are the averages of the results for five measurements, and error bars denote standard deviations. ∗p < 0.05, ∗∗p < 0.001 in comparing the NO-np-­ treated group with untreated and np-treated groups. (Reproduced from Mihu et al. (2010) under a Creative Commons Attribution 3.0 Unported Licence)

murine wound model, as evidenced by acceleration of infected wound closure in animals treated with dermatological applications of NO-releasing nanoparticles, compared with control groups. Moreover, histology evaluation of the infected wounds showed that treatment with NO-releasing nanoparticles decreased suppurative inflammation, minimized bacterial burden, and decreased collagen degradation, allowing potential mechanisms for biological activity (Martinez et al. 2009). NO-releasing chitosan nanoparticles were also applied in wound infections caused by Acinetobacter baumannii as described by Mihu et al. (2010). This treatment presented great results from the microbicidal activity of NO-releasing nanoparticles, able to reduce bacterial growth after 12 h. Figures 1.5a, b and 1.6 shows the rates of infected wounds of NO-releasing nanoparticles (NO-NP), empty nanoparticles (NP), and untreated wounds (untreated). As indicated, Fig.  1.5 shows that dermatological application of NO-releasing nanoparticles significantly increases the wound healing process, as evidenced by wound closure. In addition, collagen amount and wound healing rate also stood out compared to a control group and pure nanoparticle treatment. According to the authors, this result indicates a great advance in the treatment of skin infections caused by resistant bacteria, especially


J. C. Pieretti and A. B. Seabra

Fig. 1.6  Healing effectiveness of nitric oxide-releasing nanoparticles (NO-np) in Candida albicans-­induced burn infections. (a) Burn injuries of Balb/c mice untreated, treated with np, and treated with NO-np, day 0, 1, 5, 10, and 15. Bar = 5 mm. (b) Closure of the burn area of skin lesions of Balb/c mice relative to the initial 5-mm wound. Time points are the averages of the results of the measurements of six different wounds, and error bars denote SDs. ∗P